If your upper and lower jaws are significantly misaligned in a way that tooth movement alone cannot correct — severe underbite, open bite, facial asymmetry, or airway restriction from jaw position — surgical orthodontics may be indicated. A combined clinical and radiographic evaluation, including CBCT imaging and cephalometric analysis, determines whether orthodontics alone can achieve a stable result or whether surgical repositioning is needed.

Surgery is performed under general anesthesia, so the procedure itself is painless. Post-surgical discomfort includes facial swelling (peaking at day three), jaw stiffness, and moderate soreness managed with prescribed analgesics. Most patients describe the recovery as uncomfortable rather than acutely painful. Swelling resolves substantially within two weeks.

Most patients return to desk work within two to three weeks and normal activities within six weeks. A soft or liquid diet is required for the first two to four weeks as jaw motion gradually increases. Full bony healing takes six to eight weeks, with complete remodeling continuing for several months. Athletic and strenuous activities are restricted for six to eight weeks.

Yes — and that is part of the goal. Jaw repositioning changes facial proportions and profile. Patients with underbite gain a more balanced profile, those with long faces achieve improved vertical proportions, and asymmetric patients gain improved facial symmetry. Virtual surgical planning allows you to see a prediction of the post-surgical facial result before committing to treatment.

Orthognathic surgery for functional indications (TMJ dysfunction, obstructive sleep apnea, inability to achieve functional occlusion without surgery) may be covered partially by medical insurance. Dental insurance orthodontic benefits cover the orthodontic component. Coverage varies significantly between carriers. The administrative team assists with medical pre-authorization and benefit verification.

Braces are placed to align the teeth within each arch and to decompensate dental positions. Decompensation means removing the tilting and shifting that your teeth developed over time to compensate for the jaw discrepancy. This stage may temporarily make the bite feel worse — which is expected and necessary for the surgical correction to work properly.

Pre-surgical orthodontics typically takes 12 to 18 months. The duration depends on the starting alignment, the degree of decompensation needed, and the complexity of the surgical plan. Once the teeth are in their planned pre-surgical positions and the surgical team confirms readiness, the surgery is scheduled.

Modern orthognathic surgery uses rigid internal fixation (titanium plates and screws) rather than jaw wiring. Elastic bands between the upper and lower braces may be used for the first few weeks to guide the bite into position, but the jaw is not immobilized. This allows limited jaw opening for oral hygiene and liquid nutrition from the beginning.

Yes. Maxillomandibular advancement surgery (MMA) is one of the most effective surgical treatments for obstructive sleep apnea, expanding the pharyngeal airway by physically advancing both jaws. The airway benefit is a significant factor in treatment planning for patients whose jaw position contributes to airway restriction.

VSP uses CBCT data to create a 3D digital model of your skull, plan the osteotomies on screen, simulate the jaw repositioning, and manufacture custom cutting guides and fixation hardware that ensure the surgical result matches the planned outcome. This technology improves surgical accuracy, reduces operative time, and enhances predictability.

As with any surgery, risks include bleeding, infection, and adverse anesthetic reaction. Specific to orthognathic surgery, temporary numbness (paresthesia) of the lower lip or chin from inferior alveolar nerve proximity is common and usually resolves within weeks to months. Permanent nerve injury is rare when experienced surgeons use modern techniques and 3D-guided planning.

The combined cost of orthodontic treatment and surgery can range from $20,000 to $40,000 or more, depending on the scope of the surgical plan. Medical insurance coverage for the surgical component and dental insurance coverage for the orthodontic component can significantly reduce out-of-pocket costs. Detailed cost projections are provided after the treatment plan is finalized.

Yes. Post-surgical orthodontics typically lasts six to twelve months. This phase fine-tunes the tooth positions and bite relationships within the newly established skeletal framework. It involves detailed adjustments to achieve best interdigitation (how the upper and lower teeth mesh together) and stable occlusal contacts.

In select cases, Invisalign can manage the pre-surgical and post-surgical orthodontic phases. Surgical hooks (temporary attachments for intra-operative elastic fixation) are bonded to selected teeth. However, the majority of surgical orthodontic cases still use fixed braces because the level of tooth control required for surgical coordination is more predictable with bracket-and-wire mechanics.

This is expected and is called decompensation. Your teeth have spent years tilting and shifting to camouflage the jaw discrepancy. Pre-surgical braces remove this camouflage, exposing the true skeletal relationship — which temporarily worsens the bite. This is necessary for the surgery to achieve best correction. The worsened bite resolves immediately with the surgical jaw repositioning.